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Opinion and Commentary from TMA

Why You Should Take a Sabbatical (And How to Make the Most of It)

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Earlier this year, I did something I had wanted to do (and needed to do) for a long time. I took a sabbatical. 

Sid_Roberts_MDI am a cancer doctor and hospice physician. Dealing with death and dying and end-of-life issues can be exhausting, not just physically, but emotionally and spiritually as well. Even though I love what I do, I was getting burned out. Not every patient is pleasant or easy to work with. Stress happens. We all need a break sometimes.

There are different ways to get away, and how we go about it may depend on where we are in life. During the routine work year, breaks can come in all shapes and sizes, from the afternoon off to a three-day weekend, or a more substantial week or more off for a vacation. These standard breaks rejuvenate us and help us stay focused when we are back at work.

A sabbatical is something altogether different.

The word sabbatical has at its root what we recognize as Sabbath — rest — which has a deeply spiritual meaning of both rest and worship in Judeo-Christian theology. The idea of an extended rest from work has a long history in the academic setting, where professors are given time off from teaching to travel, write a book, or study. But I never hear of doctors taking a sabbatical. 

Doctors need it. Physician burnout is, according to some, at epidemic levels. Others call it a crisis. Let's just say, burnout among physicians is far too common. The specialty of emergency medicine reportedly has rates of burnout at nearly 60 percent, with many other specialties at 50 percent or higher. 

Burnout is basically severe, chronic stress characterized by emotional exhaustion and lack of empathy for patients, along with a cynical or negative attitude and a sense that you are spinning your wheels in your career and not getting anywhere. Does that describe any physician(s) you know? I guarantee it does. I didn't want it to describe me.

Why physician burnout exists (and is increasing) is not the subject of this essay. But if you ask doctors why, government bureaucracy, electronic health records, insurance companies, and declining reimbursement, despite longer work hours, are almost always going to come up.

Doctors need a break. More than just a scheduled afternoon off or periodic vacation. I would argue that at some point in a physician's career — if they want to stay the course for the long haul — they need to take a sabbatical.

What does a sabbatical look like? It depends on the person. My advice for those considering a sabbatical is to keep in mind three key components: time, distance, and purpose.

Time is important in order to distinguish a sabbatical from a vacation. Two weeks, for example, is not long enough to truly get away from work. You spend the first week just beginning to unwind and the second week worrying about the hell you are going to pay when you get back to the office. Four weeks is a minimum for a true sabbatical. 

Distance is important as well — certainly physical distance, in that you want to avoid the temptation to check in on work. Get out of town. Out of the country, even. In this digital age, electronic distance is also important. Are you still going to be tied to Facebook? Instagram? Twitter? Or worse, to your electronic health record? Emotional distance is key as well. Let go of the thought that only you can do what you do.

Finally, consider if there are things you've always wanted to do — books to read (or write), goals to accomplish — but you've never had the time to do them. Be creative; think outside the box.

Avoid the temptation simply to travel, where you feel obligated to visit every cathedral and museum from Athens to Zanzibar. A sabbatical is about you. Be careful, though, that you don't set unrealistic goals for your sabbatical, and that you don't come back feeling guilty that you didn't accomplish all that you set out to do. Remember, the definition of sabbatical is rest. Be still. Listen. Be open. Don't just "do!" Find out more about who you are apart from medicine.

Personally, I stayed four weeks in a seminary in Beatenberg, Switzerland where I translated German theologian and martyr Dietrich Bonhoeffer's thought-provoking book on discipleship and read a trio of books by Puritan writer John Owen. But I didn't feel guilty about whether or not I was meeting certain self-imposed goals. After all, a sabbatical is first and foremost about rest.

I am happy to report that I came back from my sabbatical not just refreshed and much less stressed, but more self-aware and ready for many more productive years of practice. Mission accomplished!

Sidney Roberts, MD, is an oncologist in Lufkin

A Sermon Every Physician Should Read

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Editor’s Note: Linda G. Fischer, a chaplain with the Palliative Care Team at MedStar Washington Hospital Center, offered the following as the opening invocation at the 2018 Interim Meeting of the AMA House of Delegates on Nov. 10, 2018. This reporter was so struck by the power of her words that I felt every Texas physician would benefit from reading them.

“Good afternoon! It’s good to be here. It’s good to be here on a beautiful autumn afternoon, Veteran’s Day weekend 2018. To those of you who serve or have served in the Armed Forces of this great country, I say thank you, thank you, thank you for your service.

“I’m grateful for the honor of offering the invocation today as you engage in the good work of the 2018 House of Delegates interim meeting. As a health care chaplain, I’ve had the opportunity to work side by side with dozens of physicians over the course of almost two decades of practice. Today, however, is the first time I’ve had a large captive audience of physicians and, in case it’s my last, I will take a moment to say a word to you that comes straight from my heart — and from my lived experience — trusting that you will hear.

“Over the years, I have watched highly skilled and dedicated physicians struggle, mightily, to practice the art of medicine in the shifting and ever-constricting landscape of health care in this country. I have watched physicians struggle to retain a sense of their vocation as healers in a culture that simply wants you to finish an exam in 15 minutes and keep moving. I have watched physicians suffer and ultimately burn out under the burden of caring too much within a system that is often deaf and blind to suffering in any form. And, at the same time, on a daily basis, I have witnessed physicians continue to show up at the bedside of the one who suffers, following their better angels, offering the very best of themselves in the service of healing as they continue to strive to be powerful, effective, and compassionate advocates for the health and well-being of all people within a medical culture that has, in some respects, lost its way.

“Now I borrow shamelessly from one of your own, Rachel Naomi Remen, MD, a physician-healer who has been a powerful voice for integrative and holistic medical care and an advocate for physician wellness for decades. Here are the words of Dr. Remen, as she speaks to ‘what matters most:’

In this difficult time in the history of medicine, I have found strength in some very simple things. Old things. There is a deep river of meaning that runs through this work, whether you are a doctor or a nurse, a psychologist, a chaplain, or a social worker. Remembering this meaning daily is what keeps us alive in this work and protects us from exhaustion. The meaning of this work has not changed in thousands of years. It is a part of our lineage. The doctors of many generations ago would have envied us our tools, our scientific reach, and our therapeutic power. But they would have understood our intention and purpose perfectly because they shared it with us. The meaning of medicine isn't science. The meaning of this work is service. Service is not a work of the intellect; service is a work of the heart and soul.

“And so I say to each of you here today and to your many colleagues — and please, my friends, spread this word: You. Are. Enough. You. It is not your scientific expertise that blesses and heals others; it is your humanity, your deep compassion, and your intention, as a healer. Thank you. Thank you. Thank you. Thank you for your service and for the good work you undertake in this House of Delegates meeting. Standing as you are able, we pray:

“Spirit of Compassion. Infinite Source of all Wisdom, Healing, and Peace. God of 10,000 Names: We stand before you in this moment with grateful hearts for the sheer gift of life and breath in the body; in gratitude for the love of family and friends; for the gift of home and country, and for the sacrifice of those who protect our freedom. We are grateful also for the privilege of having been given meaningful work to do, both at the bedside, as well as here, today, in the work that lies before you. Now, may Divine Wisdom open the door of your creative imagination, sharpen your intellect, inspire your heart, and strengthen your resolve to work for the good of all people, in the service of making health care whole. This we pray, O God, not knowing our need but trusting in you. 

“Amen. Amen. Amen.”